I'm a Family Medicine attending in my 2nd year of practice. Ask me anything

[RTC19]

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Do you see very many babies under 2 in the pediatric part of your practice?

Also, thanks so much for doing this. For some reason, we don't seem to get many primary care AMA threads around here. I think this is the first one I have seen in 4 years of relatively heavy SDN use.

 

[hsmooth]

I used to see newborns through age 18 at my previous practice. Not the same volume as a pediatrician obviously, but at that time maybe 15-20% of my practice were peds patients. I probably had about 10 peds pts I followed from birth to age 3 in the 3 years I practiced there before I moved.

Now I voluntarily gave up the peds part and work in a 18 and over internal medicine clinic.

Do you see very many babies under 2 in the pediatric part of your practice?

Also, thanks so much for doing this. For some reason, we don't seem to get many primary care AMA threads around here. I think this is the first one I have seen in 4 years of relatively heavy SDN use.

 

[RTC19]

I used to see newborns through age 18 at my previous practice. Not the same volume as a pediatrician obviously, but at that time maybe 15-20% of my practice were peds patients. I probably had about 10 peds pts I followed from birth to age 3 in the 3 years I practiced there before I moved.

Now I voluntarily gave up the peds part and work in a 18 and over internal medicine clinic.

Thanks! 🙂

 

[Dr. Stalker]

Hello, thanks for doing this thread! I have a few ignorant questions!
1. What's the difference between FM and IM residency?
2. What's the difference between attending FM vs. being an attending IM?

I ask those because an internist I shadowed (general IM), ran a pure outpatient based clinic and said he's basically FM. Thanks!

 

[hsmooth]

Every FM and IM residency is different - but in FM you'd have peds and OB rotations that IM doesn't.
IM residencies can lead to fellowships such as cardiology, nephrology, infectious disease, etc
FM residencies can lead to fellowships such as geriatrics, sports med, hospice, sleep medicine.

FM attending -- you have the option to see peds and OB. IM attending -- 18 and over.
You could become a hospitalist as either FM or IM.

Hello, thanks for doing this thread! I have a few ignorant questions!
1. What's the difference between FM and IM residency?
2. What's the difference between attending FM vs. being an attending IM?

I ask those because an internist I shadowed (general IM), ran a pure outpatient based clinic and said he's basically FM. Thanks!

 

[acslater99]

Have you felt burnt out anytime during your practice in FM? Do you think burning out is inevitable within the field of medicine regardless of what specialty one is in?

Thank you.

 

[bahdahboom]

Every FM and IM residency is different - but in FM you'd have peds and OB rotations that IM doesn't.
IM residencies can lead to fellowships such as cardiology, nephrology, infectious disease, etc
FM residencies can lead to fellowships such as geriatrics, sports med, hospice, sleep medicine.

FM attending -- you have the option to see peds and OB. IM attending -- 18 and over.
You could become a hospitalist as either FM or IM.

I’m not sure if you answered this, but what were your boards scores? Or at least a focused range?

 

[hsmooth]

I’m not sure if you answered this, but what were your boards scores? Or at least a focused range?

They were all around the 55th to 60th percentiles.

 

[deleted600623]

Every FM and IM residency is different - but in FM you'd have peds and OB rotations that IM doesn't.
IM residencies can lead to fellowships such as cardiology, nephrology, infectious disease, etc
FM residencies can lead to fellowships such as geriatrics, sports med, hospice, sleep medicine.

FM attending -- you have the option to see peds and OB. IM attending -- 18 and over.
You could become a hospitalist as either FM or IM.

Are there any FM docs that choose not to see Peds or OB?

 

[hsmooth]

Are there any FM docs that choose not to see Peds or OB?

Me!
I gave up OB right away at my first job out of residency. Depending on where you live, you will probably find there are more jobs for family practice without OB.

Now at my second job, I gave up peds too and practice at a strictly 18> and up adult medicine practice. I haven't regretted my choices so far.

 

[Matthew9Thirtyfive]

Me!
I gave up OB right away at my first job out of residency. Depending on where you live, you will probably find there are more jobs for family practice without OB.

Now at my second job, I gave up peds too and practice at a strictly 18> and up adult medicine practice. I haven't regretted my choices so far.

Given this career progression, do you think maybe IM would have better fit you?

 

[deleted600623]

Me!
I gave up OB right away at my first job out of residency. Depending on where you live, you will probably find there are more jobs for family practice without OB.

Now at my second job, I gave up peds too and practice at a strictly 18> and up adult medicine practice. I haven't regretted my choices so far.

That's good to know! And giving up those patient populations, obviously you still feel you can see enough patients to do well?

 

[676188]

I know a FM doctor who primarily runs an infectious disease clinic, and says had she known that's where she would end up, she would have just specialized in infectious disease and made more money. Do you ever feel that way, ending up in IM (essentially)? I know hindsight is 20/20.

 

[Boola Boy]

Can be highly geographic dependent. I have many FP friends who are hospitalists and live in major cities in the Midwest and mountain West region.

Could you be more specific as to the “major cities” that you’re talking about? Kansas City? Minneapolis? Or are we talking places like Columbus, Ohio? How about Indianapolis?

Do FP-trained hospitalists do procedures? Or would that also be dependent upon getting further fellowship training?

Were any of your friends NHSC Scholars?

 

[MedicineZ0Z]

Could you be more specific as to the “major cities” that you’re talking about? Kansas City? Minneapolis? Or are we talking places like Columbus, Ohio? How about Indianapolis?

Do FP-trained hospitalists do procedures? Or would that also be dependent upon getting further fellowship training?

Were any of your friends NHSC Scholars?

If someone could confirm - I always thought it was purely dependent on the hospitalist job itself. Some will be zero procedures, some want you running the ICU sometimes and doing lines/intubating etc. Not sure if the latter only wants IM trained docs. Seeing senior residents talk to recruits; my impression was the recruiter sort of lays out the duties and asks what their comfort level is with those tasks.

 

[hsmooth]

If someone could confirm - I always thought it was purely dependent on the hospitalist job itself. Some will be zero procedures, some want you running the ICU sometimes and doing lines/intubating etc. Not sure if the latter only wants IM trained docs. Seeing senior residents talk to recruits; my impression was the recruiter sort of lays out the duties and asks what their comfort level is with those tasks.

Correct. My FM hospitalist friend used to do lines and intubations when she worked at a smaller more rural hospital. Now that she works in a larger urban hospital, she doesn't do them anymore, IR does.

 

[medschoolonsteroid]

What kind of income do you think a FM physician can pull if he is willing to work longer hours (55-60+ hours a week, and assuming medium size city)?

As a med student who is going to graduate with 350k+ debt, even though money is not the major reason I get into medicine, I have to be honest that I want to pay off my debts as soon as possible. With high loan interest rates and tax, it seems like with FM income (I am seeing ~200-220k online) it will take forever to pay off the debts.

 

[Toutie]

What kind of income do you think a FM physician can pull if he is willing to work longer hours (55-60+ hours a week, and assuming medium size city)?

As a med student who is going to graduate with 350k+ debt, even though money is not the major reason I get into medicine, I have to be honest that I want to pay off my debts as soon as possible. With high loan interest rates and tax, it seems like with FM income (I am seeing ~200-220k online) it will take forever to pay off the debts.

If you continue to live on what is equal to a residents salary, you could easily pay off that amount in 5 years.

 

[Shammyguy3]

May i ask why you stopped seeing kids? And double up on the question about knowing what you're doing now would you have preferred IM?

 

[hsmooth]

Could you be more specific as to the “major cities” that you’re talking about? Kansas City? Minneapolis? Or are we talking places like Columbus, Ohio? How about Indianapolis?

Do FP-trained hospitalists do procedures? Or would that also be dependent upon getting further fellowship training?

Were any of your friends NHSC Scholars?

By more 'major' I'm reviewing to cities more along the lines of Minneapolis rather than something like Columbus. I don't think I've had any NHSC scholar friends, or at least they never mentioned it in passing.

 

[hsmooth]

I know a FM doctor who primarily runs an infectious disease clinic, and says had she known that's where she would end up, she would have just specialized in infectious disease and made more money. Do you ever feel that way, ending up in IM (essentially)? I know hindsight is 20/20.

I have interest in diversifying my income streams and not necessarily just working in the clinic every day of the week. So for now, I'm happy with FM as it leaves me some versatility. If I decide to do urgent care at some point, I can pick up peds again. If I do some telemedicine, it may be helpful to have some peds and ob/gyn experience. If the person you know is happy with working just in the clinic in a primarily infectious disease setting, perhaps it may have been better financially to go through ID fellowship through IM because then they might be reimbursed at a specialists' rate.

 

[hsmooth]

Have you felt burnt out anytime during your practice in FM? Do you think burning out is inevitable within the field of medicine regardless of what specialty one is in?

Thank you.

To some degree, yes. The first time I really felt burned out was more due to social issues in the area I was living, and it didn't align with my social values which made it difficult to live there.
It can be a drag sometimes fighting insurance companies, medicine prior authorizations, FMLA paperwork, etc. You'll have to find a way to positively cope with these ugly, but real, problems with medicine. Some people cope well. Get non-medical hobbies, spend enough time with family and friends, exercise, take time for yourself, cut down your clinical hours, etc.

 

[hsmooth]

May i ask why you stopped seeing kids? And double up on the question about knowing what you're doing now would you have preferred IM?

I really loved the clinic I interviewed at - it offered me an administrative position too, but the only downside was no peds. So I took it as a trade, to gain admin experience at the expense of kids. To be honest, taking care of peds patients wasn't my favorite area of medicine and was a challenge to me personally - I was not really too good at it. So I was happy with the trade.

In regards to your other question:
I have interest in diversifying my income streams and not necessarily just working in the clinic every day of the week. So for now, I'm happy with FM as it leaves me some versatility. If I decide to do urgent care at some point, I can pick up peds again. If I do some telemedicine, it may be helpful to have some peds and ob/gyn experience. If the person you know is happy with working just in the clinic in a primarily infectious disease setting, perhaps it may have been better financially to go through ID fellowship through IM because then they might be reimbursed at a specialists' rate.

 

[hsmooth]

What kind of income do you think a FM physician can pull if he is willing to work longer hours (55-60+ hours a week, and assuming medium size city)?

As a med student who is going to graduate with 350k+ debt, even though money is not the major reason I get into medicine, I have to be honest that I want to pay off my debts as soon as possible. With high loan interest rates and tax, it seems like with FM income (I am seeing ~200-220k online) it will take forever to pay off the debts.

Here's my quick financial analysis of your situation:

1) Start paying off some loans during residency. I wish I started doing some payback sooner. If you could even commit $5k each year of residency (a lot of FM residencies pay close to $55k per year), there you could knock your debt down to -$335k.
2) First year of practice after residency, on a 1 year guarantee @ $220k.
- Find a job that gives you a nice signing bonus, say, $20-30k taxed. So that's potentially another $15k post-tax = -$320k
- see if you can land a job that gives you loan repayment too. For instance, my current job adds an additional $1k per month for loan repayment ($750 post tax / month = $9000, dump it as extra payments to the principal of your loan = -$311k
- max your deductions for retirement: $18.5k for 401k, $5.5k IRA, $3.5k for HSA (single) - out of the $220k salary, this leaves you with $192k post tax salary, if you deduct say 25-28% for taxes that's $138k take home. Say you live like a resident for a few years and your yearly expenses are around $50k (which you can still live really great on $50k). that leaves you with $88k per year.
- invest $20k of that every year in an investment / taxable account. That leaves you with $68k per year, or about $5.5k to put towards your loans every month.
3) If you're able to refinance your loan to a better rate, do it! For example now, with $311k in debt remaining and paying $5.5k every month towards it at 5% interest, it would take you 5.5 years to pay it off.

Loan pay off calculator:
Pay Off Loan Calculator - Find out how long it will take to pay off your loan | Calculators by CalcXML

BUT WAIT THERE'S MORE!
This is all presuming you 'just' work 36 hours at your standard office job.

If you want to work hard, say in your first year you work 4 days a week to equal 36 full time hours in the clinic, and on the day off, you work a 10 hour shift at urgent care to make another $1100 per week (or $3k extra, after tax, per month). Apply that 3k monthly to the principal and now you're talking 3 years and 4 months to pay it off.

BUT WAIT THERE'S MORE!
Let's say after your first year in practice, you built up a busy, large patient panel and you're quick and efficient and can see 30 patients a day in the 4 clinic days in the office. Taking 6 weeks of vacation, you'd make $400,000 just in your clinic job. ($260k take home). Don't blow your extra income on fancy cars or luxuries, maintain that $50k / year expenses, and you can dump in an extra $100k theoretically in years 2-3 and voila, you would have paid off your loans in 2+ years!

Main gist of it: side hustle, pick up extra shifts, practice good but efficient medicine, make money, don' tallow your expenses to balloon out of control, and you can pay off your large loan in 3-5 years with a bit of discipline.

Disclaimer: I did this math in between seeing patients so I hope I calculated it right.

Side note: If you still aren't sure you can do it, use me as an example. I will pay off $200k in loans in 5 years after residency, while maxing out all my retirement accounts and investments, and saved enough also to put down $200k for construction loan to build a house. I plan on retiring by age 53-55 once the baby is out the house!

 

[Eagleye2]

Earlier you stressed the importance of being educated in finances, what are some resources you used that helped you learn how to most effectively pay off loans while still living well

 

[hsmooth]

Earlier you stressed the importance of being educated in finances, what are some resources you used that helped you learn how to most effectively pay off loans while still living well

websites:
White Coat Investor - they have a book as well
Physician on Fire
Bogleheads financial forum

books:
The Bogleheads' Guide to the Three-Fund Portfolio: How a Simple Portfolio of Three Total Market Index Funds Outperforms Most Investors with Less Risk

 

[medschoolonsteroid]

Here's my quick financial analysis of your situation:

1) Start paying off some loans during residency. I wish I started doing some payback sooner. If you could even commit $5k each year of residency (a lot of FM residencies pay close to $55k per year), there you could knock your debt down to -$335k.
2) First year of practice after residency, on a 1 year guarantee @ $220k.
- Find a job that gives you a nice signing bonus, say, $20-30k taxed. So that's potentially another $15k post-tax = -$320k
- see if you can land a job that gives you loan repayment too. For instance, my current job adds an additional $1k per month for loan repayment ($750 post tax / month = $9000, dump it as extra payments to the principal of your loan = -$311k
- max your deductions for retirement: $18.5k for 401k, $5.5k IRA, $3.5k for HSA (single) - out of the $220k salary, this leaves you with $192k post tax salary, if you deduct say 25-28% for taxes that's $138k take home. Say you live like a resident for a few years and your yearly expenses are around $50k (which you can still live really great on $50k). that leaves you with $88k per year.
- invest $20k of that every year in an investment / taxable account. That leaves you with $68k per year, or about $5.5k to put towards your loans every month.
3) If you're able to refinance your loan to a better rate, do it! For example now, with $311k in debt remaining and paying $5.5k every month towards it at 5% interest, it would take you 5.5 years to pay it off.

Loan pay off calculator:
Pay Off Loan Calculator - Find out how long it will take to pay off your loan | Calculators by CalcXML

BUT WAIT THERE'S MORE!
This is all presuming you 'just' work 36 hours at your standard office job.

If you want to work hard, say in your first year you work 4 days a week to equal 36 full time hours in the clinic, and on the day off, you work a 10 hour shift at urgent care to make another $1100 per week (or $3k extra, after tax, per month). Apply that 3k monthly to the principal and now you're talking 3 years and 4 months to pay it off.

BUT WAIT THERE'S MORE!
Let's say after your first year in practice, you built up a busy, large patient panel and you're quick and efficient and can see 30 patients a day in the 4 clinic days in the office. Taking 6 weeks of vacation, you'd make $400,000 just in your clinic job. ($260k take home). Don't blow your extra income on fancy cars or luxuries, maintain that $50k / year expenses, and you can dump in an extra $100k theoretically in years 2-3 and voila, you would have paid off your loans in 2+ years!

Main gist of it: side hustle, pick up extra shifts, practice good but efficient medicine, make money, don' tallow your expenses to balloon out of control, and you can pay off your large loan in 3-5 years with a bit of discipline.

Disclaimer: I did this math in between seeing patients so I hope I calculated it right.

Side note: If you still aren't sure you can do it, use me as an example. I will pay off $200k in loans in 5 years after residency, while maxing out all my retirement accounts and investments, and saved enough also to put down $200k for construction loan to build a house. I plan on retiring by age 53-55 once the baby is out the house!

Wow that's a very detailed plan. This gives me a lot of hope. Thanks for taking the time to do it.

I always thought 220k was for those FM who work 60-hour weeks. I'm relieved that I don't have to exclude FM from my options because of my debts.

 

[hsmooth]

Wow that's a very detailed plan. This gives me a lot of hope. Thanks for taking the time to do it.

I always thought 220k was for those FM who work 60-hour weeks. I'm relieved that I don't have to exclude FM from my options because of my debts.

No problem!
No, $220k is more like 36 hours work per week.
Good luck.

 

[hsmooth]

I'm stuck at the hospital for a while (not for work though), anyone want to help me pass the time with some questions??

 

[Shammyguy3]

I'm stuck at the hospital for a while (not for work though), anyone want to help me pass the time with some questions??

Whats the toughest thing about being a FM doc?

 

[hsmooth]

Here are a few challenges:

Sometimes someone can come in and have such a complex medical history or have some strange ailment that you just feel overwhelmed and not sure how to even start helping them.

Managing the 'busy work' outside of direct patient care time: filling out forms, FMLA forms, insurance issues, medication denials, medication prior authorization, pt phone calls or email messages.

Managing patient's expectations with treatment plans: your cough isn't going to go away by tomorrow even if you get an antibiotic, etc.

Managing the administration's expectations: no, you can't physically squeeze in 3 extra patients when you're already seeing 30 in a day.

Dealing with compliance, quality metrics, reports. Remembering to click the right boxes in the EMR to get credit for certain measures.

 

[hsmooth]

Whats the toughest thing about being a FM doc?

Here are a few challenges:

Sometimes someone can come in and have such a complex medical history or have some strange ailment that you just feel overwhelmed and not sure how to even start helping them.

Managing the 'busy work' outside of direct patient care time: filling out forms, FMLA forms, insurance issues, medication denials, medication prior authorization, pt phone calls or email messages.

Managing patient's expectations with treatment plans: your cough isn't going to go away by tomorrow even if you get an antibiotic, etc.

Managing the administration's expectations: no, you can't physically squeeze in 3 extra patients when you're already seeing 30 in a day.

Dealing with compliance, quality metrics, reports. Remembering to click the right boxes in the EMR to get credit for certain measures.

 

[Shammyguy3]

Here are a few challenges:

Sometimes someone can come in and have such a complex medical history or have some strange ailment that you just feel overwhelmed and not sure how to even start helping them.

Managing the 'busy work' outside of direct patient care time: filling out forms, FMLA forms, insurance issues, medication denials, medication prior authorization, pt phone calls or email messages.

Managing patient's expectations with treatment plans: your cough isn't going to go away by tomorrow even if you get an antibiotic, etc.

Managing the administration's expectations: no, you can't physically squeeze in 3 extra patients when you're already seeing 30 in a day.

Dealing with compliance, quality metrics, reports. Remembering to click the right boxes in the EMR to get credit for certain measures.

Thanks for the detailed response. What are your thoughts on patients trying to use the internet to self diagnose them, and how their "research" may play into those of expectations of treatment?

 

[medschoolonsteroid]

It is not related to FM physicians but I will ask anyway.

What do you think is the biggest problem of the current healthcare system?

Some people complain that physicians in the US are earning too much in comparison to other developed countries, and that countributes to the high healthcare expenditure. what do you think?

 

[hsmooth]

Thanks for the detailed response. What are your thoughts on patients trying to use the internet to self diagnose them, and how their "research" may play into those of expectations of treatment?

I honestly don't mind it so much. It's easy to address. If I get the sense a patient is worried about something they read on the internet, I ask, "Is there something in particular you've read or heard about that you're concerned about?"

They'll often answer, "yes, I know I'm not supposed to do this, but I read on the internet that it could be ______".

So then it's easy to either reassure them why it isn't ______ . Sometimes, no amount of reassurance will help ease their mind. At that point, I offer to do X, Y, and Z tests which would rule out _____ , with the caveat that there's a really good chance those tests will be normal and it may be extra health care costs they don't need to spend. At this point, they can make an informed decision on whether to proceed with any further testing or not.

This approach works generally pretty well for me. Some exceptions are overly anxious, hypochondriac type patients, or those with mental health concerns. In those cases, you can really find yourself in a situation debating about whether to keep going down the rabbit hole of more and more testing (and at what cost).

 

[hsmooth]

It is not related to FM physicians but I will ask anyway.

What do you think is the biggest problem of the current healthcare system?

Some people complain that physicians in the US are earning too much in comparison to other developed countries, and that countributes to the high healthcare expenditure. what do you think?

High cost for health care with average to middle of the road health care outcomes. This is a loaded topic that encompasses many different subjects - health care, politics, socioeconomics, etc. I never practiced as a physician in a country with universal health care / socialized health care, but having grown up in a place that had it, I had experience from the patient side of things. I never had to worry about how much an office visit or test would cost because my taxes helped pay for those things.

For an average office visit, I get paid about $50-75 while patient's insurance is billed $200-$400. I have a family member who is practicing in family medicine in Canada and they make roughly the same amount as I do.

I'd be happy to discuss more if you'd like, but I'll leave my reply here for the time being.

 

[spancs]

Hi hsmooth!,

I hear a lot of talk about how unfamiliar many new physicians are with the financial aspect of medicine and with how to run the business side. I’m an OMS1 and my school offers a dual degree MBA/DO program. I’m having a hard time deciding if a masters in business would really be worth it or not. While I am trying to be open minded as far as deciding on a specialty, my goal has always really been rural family medicine. Do you think an MBA would be worth the time/money for a rural FM doc? Were you able to figure out the business side of things just fine after you graduated residency?

 

[Bacchus]

Wow that's a very detailed plan. This gives me a lot of hope. Thanks for taking the time to do it.

I always thought 220k was for those FM who work 60-hour weeks. I'm relieved that I don't have to exclude FM from my options because of my debts.

Based on my wRVU rate which is on the lower end, the wRVUs I had last year would put me at 225000 or so. I work 36 patient hours a week so it is definitely doable you just need to be accurate and aggressive with your billing strategies. I don’t know about my colleague here, or your knowledge of billing, but on average for my office the 99213/99203 and 99214/99204 split is about 20/70 and then miscellaneous charges sprinkled in. If you do a lot of peds and Medicare wellness visits the wRVUs climb quickly. The peds well visits are laden with vaccine administrations which get an associated wRVU associated with them in addition to the visit because of the vaccine counseling. My point is, it’s not hard to have an excellent income with good lifestyle and work balance, usually. Also, should be mentioned, I have residents billing under me so I get those wRVUs and see patients on 20 minute blocks. If you see patients every 15 minutes you could see on average 7-8 more patients than me.

 

[Bacchus]

Hi hsmooth!,

I hear a lot of talk about how unfamiliar many new physicians are with the financial aspect of medicine and with how to run the business side. I’m an OMS1 and my school offers a dual degree MBA/DO program. I’m having a hard time deciding if a masters in business would really be worth it or not. While I am trying to be open minded as far as deciding on a specialty, my goal has always really been rural family medicine. Do you think an MBA would be worth the time/money for a rural FM doc? Were you able to figure out the business side of things just fine after you graduated residency?

Not to hijack, but an extra year if your goal isn’t admin isn’t needed in my opinion. You will learn quickly all the stuff you don’t learn in residency where you’re often shielded from all the behind the scenes.

 

[spancs]

Not to hijack, but an extra year if your goal isn’t admin isn’t needed in my opinion. You will learn quickly all the stuff you don’t learn in residency where you’re often shielded from all the behind the scenes.

I appreciate your reply, Bacchus. So this particular MBA/DO program is still a 4 year program, but a lot of the MBA work is done during the summers in between years. There are MBA classes sprinkled in during the year, but most of it is during the summers. That would certainly get in the way of research opportunities, but I’ve been under the impression that research isn’t 100% necessary for primary care anyway. I’ve been leaning more towards not applying to the MBA because so many FM physicians before have just “figured it out” after residency, but I wanted to hear the opinions of those who have been through it (like yourself). Thank you for your input!

 

[hsmooth]

Hi hsmooth!,

I hear a lot of talk about how unfamiliar many new physicians are with the financial aspect of medicine and with how to run the business side. I’m an OMS1 and my school offers a dual degree MBA/DO program. I’m having a hard time deciding if a masters in business would really be worth it or not. While I am trying to be open minded as far as deciding on a specialty, my goal has always really been rural family medicine. Do you think an MBA would be worth the time/money for a rural FM doc? Were you able to figure out the business side of things just fine after you graduated residency?

As what @Bacchus said, if your main goal is rural FM doc - MBA isn't needed. If you have any higher administrative aspirations, such as CMO of a medical group or hospital, then MBA would be worth it.

 

[hsmooth]

Based on my wRVU rate which is on the lower end, the wRVUs I had last year would put me at 225000 or so. I work 36 patient hours a week so it is definitely doable you just need to be accurate and aggressive with your billing strategies. I don’t know about my colleague here, or your knowledge of billing, but on average for my office the 99213/99203 and 99214/99204 split is about 20/70 and then miscellaneous charges sprinkled in. If you do a lot of peds and Medicare wellness visits the wRVUs climb quickly. The peds well visits are laden with vaccine administrations which get an associated wRVU associated with them in addition to the visit because of the vaccine counseling. My point is, it’s not hard to have an excellent income with good lifestyle and work balance, usually. Also, should be mentioned, I have residents billing under me so I get those wRVUs and see patients on 20 minute blocks. If you see patients every 15 minutes you could see on average 7-8 more patients than me.

You've got a good set up. My 99213:99214 ratio is probably 20:60 with remaining 20 as physicals or Annual wellness visits. I sprinkle in 2-4 telemedicine consults throughout the work day when I have a lull to add on an extra $100 or so to my day.

 

[RTC19]

What tends to be your bread and butter pathology? I imagine there is a lot of DM2, hypertension, dyslipidemia and depression management. Maybe office gyn?

What other sort of pathology tends to show up a lot?

 

[hsmooth]

What tends to be your bread and butter pathology? I imagine there is a lot of DM2, hypertension, dyslipidemia and depression management. Maybe office gyn?

What other sort of pathology tends to show up a lot?

Mental health, A LOT. Depression, anxiety, ADHD. Be comfortable with it because you might not have easy access to psychiatry.
Hypertension, Diabetes, Hyperlipidemia
Asthma, COPD, allergies and their exacerbations
CHF and its exacerbations
Physicals, preventative medicine, obesity
substance abuse
Chronic pain
kidney disease
hypothyroidism
Well child exams
If you're a male doc, you'd naturally get lots of male genitourinary issues. Female doc, more female gyn stuff.
Preoperative exams
chronic musculoskeletal issues - gout, arthritis
GERD

Acute issues:
aches and pains, musculoskeletal issues
coughs, colds, sinus infections
dizzyness
STD management
abdominal pain
headaches, migraines
derm issues, rashes
fatigue
fever
urinary tract infections

As family med, often you'll have the chance to do the 'first workup' for a previously not diagnosed condition yet. Then refer to the appropriate specialist for continuing care. You'll get the chance to diagnose pathology that other doctors may have blown off or missed. Things I've caught that others have missed or didn't have the time to do the appropriate workup: heart disease (flail valves, heart failure, cardiac sarcoidosis), rheumatological diseases, cancers, mental health issues manifesting as physical complaints.

Edit: My humble brag is that I'm averaging 1 life per year so far that I know of that I directly saved someone's life. These are patients that were misdiagnosed, or not fully worked up, or if I hadn't intervened in their care they likely would have died. So it's a pretty rewarding experience to go through. It's like, "holy s**t, if I hadn't met this person that day, they'd legit be dead at home right now".

 

[Matthew9Thirtyfive]

I don’t know if you listen to it or have even heard of it, but there is a cool podcast called Curbsiders. If you don’t know if, it’s a podcast that is run by primary care docs that presents topics using expert interviews directed to primary care docs. It’s pretty interesting.

Anyway, my question is this: on the latest episode, an ID doc talks about how as a primary care doc, it is totally reasonable to manage HIV patients yourself if they are someone you caught on a screening or are otherwise not super complicated. HIV care interests me, but I’m not sure it interests me enough to pull me into ID. Do you know any primary care docs that manage their own HIV patients?

As an aside, he also said that when counseling newly diagnosed HIV patients, he assures them that given the choice between a diagnosis of HIV or DM2, he would pick HIV every time because it’s easier to manage and likelihood of having issues down the line is lower. How do you feel about that?

 

[676188]

I don’t know if you listen to it or have even heard of it, but there is a cool podcast called Curbsiders. If you don’t know if, it’s a podcast that is run by primary care docs that presents topics using expert interviews directed to primary care docs. It’s pretty interesting.

Anyway, my question is this: on the latest episode, an ID doc talks about how as a primary care doc, it is totally reasonable to manage HIV patients yourself if they are someone you caught on a screening or are otherwise not super complicated. HIV care interests me, but I’m not sure it interests me enough to pull me into ID. Do you know any primary care docs that manage their own HIV patients?

As an aside, he also said that when counseling newly diagnosed HIV patients, he assures them that given the choice between a diagnosis of HIV or DM2, he would pick HIV every time because it’s easier to manage and likelihood of having issues down the line is lower. How do you feel about that?

I spent 8 weeks this past summer with a FM doc who ran an infectious disease clinic for Hep C and HIV patients. Very interesting stuff. I will say that the Dr. often said had she known she was going to end up seeing mainly infectious disease patients, she would have done a fellowship, and gotten paid more.

 

[Matthew9Thirtyfive]

Not sure how things were when this particular doctor got her training and in your particular region, but....
EDIT HOLD ON
And bear in mind also that FM training takes 3 years and IM + ID fellowship takes 5.


Source: Medscape: Medscape Access

Not to derail further, but it's interesting that neurosurgery isn't on there.

 

[676188]

Not sure how things were when this particular doctor got her training and in your particular region, but....

And bear in mind also that FM training takes 3 years and IM + ID fellowship takes 5, so that ~10k difference in salary takes a few decades to make up if you assume an ID fellow is making a generous salary of $60k a year rather than what a fresh FM attending would make.


Source: Medscape: Medscape Access

No idea either, honestly. It's quite possible I'm in a low paid area.

 

[Matthew9Thirtyfive]

Huh, I hadn't noticed! Not sure why that is.

Probably so far off the charts it dwarfs the rest of the bars lol.

 

[boulderbud49]

Mental health, A LOT. Depression, anxiety, ADHD. Be comfortable with it because you might not have easy access to psychiatry.
Hypertension, Diabetes, Hyperlipidemia
Asthma, COPD, allergies and their exacerbations
CHF and its exacerbations
Physicals, preventative medicine, obesity
substance abuse
Chronic pain
kidney disease
hypothyroidism
Well child exams
If you're a male doc, you'd naturally get lots of male genitourinary issues. Female doc, more female gyn stuff.
Preoperative exams
chronic musculoskeletal issues - gout, arthritis
GERD

Acute issues:
aches and pains, musculoskeletal issues
coughs, colds, sinus infections
dizzyness
STD management
abdominal pain
headaches, migraines
derm issues, rashes
fatigue
fever
urinary tract infections

As family med, often you'll have the chance to do the 'first workup' for a previously not diagnosed condition yet. Then refer to the appropriate specialist for continuing care. You'll get the chance to diagnose pathology that other doctors may have blown off or missed. Things I've caught that others have missed or didn't have the time to do the appropriate workup: heart disease (flail valves, heart failure, cardiac sarcoidosis), rheumatological diseases, cancers, mental health issues manifesting as physical complaints.

Edit: My humble brag is that I'm averaging 1 life per year so far that I know of that I directly saved someone's life. These are patients that were misdiagnosed, or not fully worked up, or if I hadn't intervened in their care they likely would have died. So it's a pretty rewarding experience to go through. It's like, "holy s**t, if I hadn't met this person that day, they'd legit be dead at home right now".

I'm pretty interested in working with patients with mental health issues, and you mentioned mental health as the first thing that you see most frequently. Do you normally refer these patients to psychiatrists to work with, or continue treating them? Do you feel you normally have the time you need to give them the help that they need? Or do patient volumes make it difficult?